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Myocardial Irritability

Question. Is myocardial irritability a complication frequently experienced by patients with clostridial myonecrosis?

Answer. Several clostridial exotoxins have cardiotoxic side-effects that can result in significant myocardial irritability, especially in children. Common dysrhythmias that have been seen in both adults and children include wandering atrial pacemaker, atrial tachycardia, nodal rhythms, unifocal and multifocal premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation.

These patients should receive continuous cardiac monitoring during the course of their illness to rapidly identify and treat the arrhythmias, while simultaneously undergoing detoxification to prevent additional complications. Iatrogenically-induced arrythmias have been associated with the introduction of CVP catheters, but this complication can be prevented by not allowing the catheter to enter the right atrium.

The action of hyperbaric oxygen in decreasing the toxin load appears to be adequate treatment for most supranodal arrhythmias. In more severe arrhythmias or scenarios where cardiac function is significantly compromised, specific cardio-pharmacologic agents should be used without hesitation, including rapid digitalization of patients in cardiac failure.

Excerpted with permission from the publisher, Best Publishing Company, from Hyperbaric Medicine Practice, 3rd Edition by Eric P. Kindwall, MD and Harry T. Whelan, MD. Copyright 2008. 

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